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Geoffrey Ching, Murad Al-Obthani, Albert Covello, Martin McCarthy, Simon Paul Holland, Rusty Ritenour, Sonia Yeung, Alfonso Iovieno; Incidence of and Risk Factors for Cystoid Macular Edema Post-Descemet Membrane Endothelial Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6289.
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© ARVO (1962-2015); The Authors (2016-present)
Descemet Membrane Endothelial Keratoplasty (DMEK) has been associated with postoperative cystoid macular edema (CME). In this study, we aimed to assess the rate of postoperative DMEK, the significance of patient factors that possibly contributed to CME occurrence post-DMEK, and the effect of CME on postoperative visual outcomes.
288 patients (88 male, 148 female, mean age 71 years, range 34-96) who had undergone DMEK were included. Exclusion criterium was less than 3 months of follow-up post-DMEK or history of DMEK surgery combined with any non-cataract extraction and IOL insertion procedure. Visual acuity was expressed in LogMAR. Regression analysis was used to assess the contribution of risk factors such as a history of diabetes, concomitant cataract extraction, triple DMEK, single DMEK, preoperative prostaglandin use, glaucoma, history of uveitis, preoperative presence of epiretinal membrane, and rebubbling post-DMEK.
CME occurred post-DMEK at a rate of 3.81% ± 0.08%. None of the examined risk factors were found to significantly elevate risk of post DMEK CME. Postoperative vision recovery did not differ with occurrence of CME, as patients without CME achieved a postoperative logMAR CDVA of -0.35 ± 0.032 while those without CME achieved a postoperative logMAR CDVA of -0.10 ± 0.19 (p= 0.63). Time to resolution of CME in patients with available data averaged 4.67 ± 1.08 months. 67% ± 3.9% of patients were treated using and NSAID and a steroid whereas the remaining 33% ± 3.9% of CME patients were treated using NSAIDs, steroids, in addition to at least one intravitreal bevacizumab injection.
Increase of CME rates post DMEK may not be as large as previously reported in the literature. Risk factors assessed such as a history of diabetes, surgery, or type of DMEK did not significantly increase the risk of CME. Visual outcomes were not affected significantly by the occurrence of CME.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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